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7
HEALTH MESSAGES AND STRATEGIES FOR
DISSEMINATION
In the previous chapters, speakers identified the divides that exist
between sustainability and environmental protection and health
promotion in the United States and the larger international community,
and presented potential solutions to bridging these gaps. This chapter
focuses on discussing strategies for disseminating these solutions within
the environmental health community, as well as broader groups. A
summary of this discussion follows, which mainly emphasizes
communication strategies for connecting with the general public in the
United States.
Linda McCauley started this discussion by stating that individuals
need to be challenged to think about how to take information and
collectively help chart a course for environmental health. McCauley
noted the need for the environmental health community to define the
messages and identify the audience upfrontâwhich may include U.S.
government agencies or the global communityâin order to have an
impact with its communication strategy. She asked the workshop
participants to share their thoughts on the communication messages that
should be utilized to move forward the key environmental health and
sustainability issues that were discussed during the workshop.
Martin Philbert noted that scientists often labor under the
misconception that because they can define risks to the fifth or sixth
decimal place, this information will influence the person making daily
decisions in the supermarket. Philbert stated that the general public does
not understand, for instance, the implications that purchasing high-
thread-count Egyptian cotton sheets may have on a worker thousands of
miles away. Philbert noted there is a disconnect between the scientist,
who imagines a world in which sustainability prevails, and the general
public, which needs to be convinced that sustainability is the next logical
117

118 PUBLIC HEALTH LINKAGES WITH SUSTAINABILITY
step to a state of improved health for everyone. Philbert agreed with the
need to identify who to convince, the steps needed, and the mechanisms
available to achieve the goal.
Kirk Smith noted the need to focus on problems that actually cause
substantial ill health and contribute to the global burden of disease
estimates. He added that the public often reacts to stories of more severe
chemicals or disease (such as childhood cancer), than to more common
hazards that result in greater rates of morbidity and mortality (such as
accidents). Lauren Zeise added that we often cannot identify the
cumulative effects of low-level environmental exposures in the myriad of
things we are exposed to in our daily lives. Zeise agreed with the need to
look at the big contributors, but noted that she did not know the extent to
which the attributable risk of these low-level chemical exposures can be
assessed with the current methodology. Zeise noted that it would be
useful to better understand the extent to which some of the underlying
environmental chemicals and chemicals present in food and food
processing contribute to death and disease.
Jamie Bartram noted the need to address both communication that is
internal to the environmental health community, as well as commun-
ication that is external. With regard to internal communication, he said,
two things that have come up in our discussions are the need to talk
about (1) metrics and approaches to sustainability and environmental
health, and (2) how we can bring the available evidence usefully together
to further environmental health and sustainability initiatives. Bartram
noted that with external communication, the messaging in many domains
of science tends to focus on what does not work and uses that as a basis
of how to proceed, rather than looking at what does work. Bartram
explained that the communication strategy should be relevant to people
in terms of enabling or empowering them to act in ways that they
perceive to be relevant to their lives. This form of communication is
much better than a very complex risk message, he said, which even if
conveyed correctly is not something that can be translated into
immediate practical action for people.
John Spengler stated that people in the Ministry of Environment in
the Netherlands found that imagery was effective in getting the
population to support their National Environmental Policy Plan. For
instance, he said, the communication strategy included multiple images
of what the Netherlands would look like from a population and
environmental perspective 25 years into the future without the policy

HEALTH MESSAGES AND STRATEGIES FOR DISSEMINATION 119
plan, and the public did not want that image. Linking this to the work of
the Institute of Medicine, he said, we have to do more to get our
messages out to the public, which may include investing in short videos
with experts providing effective sound bites and with imagery around the
message. Spengler noted that this type of communication would be better
than just releasing a hard copy report or summary that remains on the
bookshelf in most cases. Additionally, Spengler said, we have to take our
messages and disseminate them into PowerPoint slides and lecture
materials, so the information is packaged for environmental health
courses in graduate schools, undergraduate schools, and community
colleges across the country.
Wilfried Kreisel introduced the topic of health literacy and noted that
for a health message to be effective the audience needs to understand the
health message, which often depends on where they are located on the
social gradient in society. Kreisel stated that in the United States we
would like to reach those at the lower end of the social gradient, but we
have not been able to improve the health literacy among the poorer
segments of society. He noted that our health messages tend to reach a
few and not really those who are crucial to improve population health,
which is important in the debate on health equity, health literacy, and
health sustainability.
Nsedu Witherspoon pointed out that many groups in the United States
are certainly working on targeted messages at the local level, including
messages on air pollutants and pesticide exposure targeted at mothers
and pregnant women. Witherspoon noted that we should appreciate that
these localized efforts are under way and perhaps try to uplift these
efforts or assist in discussing the action or implementation steps. Robert
Goldsmith continued with this topic area and noted the need to find
common ground, not just with groups with similar messaging but also
with groups on the other side of some of these environmental health and
sustainability issues, to build bridges and move things forward in a
collaborative way.
Goldsmith stated that the best solutions to put forward may be
innovations that have both a sustainability impact as well as a return on
investment. He noted that efforts could focus on validating potential
solutions to these high-level environmental health and sustainability
issues, with the pros and cons adequately presented for policy makers to
debate the merits. Over the course of the workshop, Goldsmith said,
wonderful solutions were presented that could work on the global scale

120 PUBLIC HEALTH LINKAGES WITH SUSTAINABILITY
or on the local scale, and it would be nice to see this group develop
innovative messaging to introduce these issues to broader groups.
Richard Jackson then noted that the good solutions tend to solve multiple
problems or challenges, and this is a positive message that may resonate.
Luiz GalvÃ£o stated that with the green economy discussions taking
place, there is a perfect opportunity to place environmental health at the
center of the agenda. Additionally, GalvÃ£o said, there are grassroots
efforts targeting noncommunicable diseases (NCDs) in developing
countries that provide an opportunity to inform discussions with some of
the information that was presented here. GalvÃ£o emphasized that he sees
this as a great opportunity for how environmental health can become a
perfect solution for a perfect storm. GalvÃ£o added that he is uncertain of
the exact processes that should be employed, but noted that we should
take advantage of the possibility to collaborate with other experts or
advocacy groups who are present at large meetings focusing on the green
economy or NCDs, in addition to finding ways to collaborate with
outside groups leading up to and during the Rio+20 conference.

In 1992 world leaders met at the Earth Summit in Rio de Janeiro to reaffirm the Declaration of the United Nations Conference on the Human Environment that was established on June 16, 1972 in Stockholm. The meeting resulted in the adoption of Agenda 21 by the member states which is a framework for the transition to a more sustainable world. In 2012 the members gathered to assess and reaffirm the importance of progress towards the efforts of Agenda 21.

In response to this the Institute of Medicine's (IOM's) Roundtable on Environmental Health Sciences, Research, and Medicine held a workshop to inform the policies that are discussed at the 2012 Earth Summit. The workshop, held in Woods Hole, Massachusetts on July 25-26, 2011, focused on the issue of sustainability and health as well as the linkages that are currently present between the two.

The workshop included presentations and discussions which are summarized in Public Health Linkages with Sustainability: Workshop Summary. The report presents how different areas of public health, such as food and water resources, link to sustainability and opportunities or venues that can be examined.

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